On Jan. 19, Massachusetts votes for a new senator. Will the Bay State upend politics the way Pennsylvania did in 1991, sending Washington a strong message on health care?

For weeks, the Massachusetts special election was of interest only to political junkies. The question wasnt whether the Democrats would win, but the margin of victory.

It should be a forgone conclusion in a state where registered Democrats outnumber Republicans 3-to-1 and hasnt been represented by a Republican senator since Richard Nixons landslide. Adding to the advantage: As of late fall, Democrat Martha Coakley outspent Republican Scott Brown by roughly 10-to-1.

Yet, in recent polling, theres been a major shift. In an early January poll, Rasmussen Reports found Brown narrowing a 31-point gap to a single digit (and just 2 percentage points among voters absolutely certain to vote); Public Policy Polling gives an edge to Brown, though a Boston Globe poll still suggests a Democratic lead. And while days remain in the campaign, the GOP candidate has the momentum.

Back in 1991, with President George H.W. Bush cruising to re-election, Pennsylvania had a special election for the Senate. Attorney General Dick Thornburgh, a former governor of the Keystone State, ran against a largely unknown opponent, Harris Wofford, who focused on a few issues: Health care was first and foremost. Thornburgh lost, and the issue became key to Bill Clintons successful campaign.

Brown, like Wofford, has focused on just a handful of issues. First and foremost: If he wins, hell vote no to Obamacare.

With Senate Majority Leader Harry Reids bill passing solely on partisan lines 60 to 40, a Massachusetts surprise would essentially kill the current reforms. Its turning into a referendum, like that Pennsylvania election, on approval of the White Houses health care management.

Why the shift? Bay State voters may be decidedly liberal, but they understand a thing or two about sweeping health reforms, having passed their own legislation back in 2006. An expansion of Medicaid, subsidies for those with low income, an insurance exchange, a mandate for individuals to buy insurance -- all of these ideas that are core to Obamacare already passed in the Bay State a few years ago.

And, by all accounts, the experiment has been problematic. Yes, the total number of uninsured has dropped. But insurance premiums soared, boasting double-digit annual increases. The Boston Globe recently proclaimed that Massachusetts now has the highest insurance costs in the country.

Needless to say, state officials are at a loss -- and on the hook. Program spending is about 85 percent higher than originally projected. Recently discussed proposals include a return to managed care-like capitation and even price controls.

Massachusetts first looked to health reform for the same reason that the nation has. Costs had soared without a clear rise in value. Consider that premiums have about doubled nationally since 2000. Would even the slickest Washington lobbyist attempt to argue that health care is twice as good as it was at the beginning of this decade?

And no wonder. For every dollar spent on health care, Americans directly pay just 12 cents. There is little incentive for people to economize.

Bay State officials failed to address this economic problem in any way. As they were implementing the plan, they insisted that basic health insurance cover countless services and offer wide subsidies. In other words, for a health system plagued by subsidies and regulations, officials decided to offer up more of the same.

Next week, Massachusetts voters go to the ballot box in a close election. The Democrat will probably win, but if a state that voted for Obama over McCain by 26 percentage points has hesitation on government-heavy health reforms, Democrats are in for an unpleasant election year.